American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary treatment for chronic pancreatitis?

1. Opioids for pain management

2. Antibiotics

3. Surgical intervention

4. Pancreatic enzymes

The correct answer is: Pancreatic enzymes

In chronic pancreatitis, the primary issue is the irreversible damage to the pancreatic tissue, which significantly impacts its ability to produce digestive enzymes. This leads to malabsorption of nutrients, resulting in weight loss and diarrhea. The key treatment for this condition focuses on addressing the insufficiency of pancreatic enzyme production. Pancreatic enzyme replacement therapy is critical because it helps to break down food and improve nutrient absorption, alleviating the gastrointestinal symptoms associated with malabsorption. By providing these enzymes, patients can better digest fats, proteins, and carbohydrates, which helps in replenishing lost weight and improving overall nutrition. Pain management is indeed a component of the treatment for chronic pancreatitis, particularly with opioids, but it is not the primary approach since it does not rectify the underlying insufficiency of the pancreatic function. Antibiotics are generally not part of the standard management unless there is a specific infective complication. Surgical intervention may be considered in certain cases for pain relief or if there are anatomical issues, but it is not the first-line treatment for managing enzyme deficiency. Therefore, the provision of pancreatic enzymes stands out as the fundamental treatment strategy for effectively managing chronic pancreatitis.